Incidence and risk factors for new-onset interstitial lung disease

Analysis of data from the European Scleroderma Trials and Research (EUSTAR) group showed that in patients with systemic sclerosis (SSc), interstitial lung disease (ILD) can appear at any time. Incidence throughout the disease course was similar. The authors recommend screening SSc patients after a negative baseline high-resolution computed tomography (HRCT).

EUSTAR was launched in 2004, aiming to unify research efforts in the field of SSc. This EUSTAR analysis aimed to estimate the annual incidence of ILD in SSc patients and identify risk factors for new-onset ILD. Dr Liubov Petelytska (Bogomolets National Medical University, Kyiv, Ukraine) presented the results.

Of 23,195 SSc patients from the EUSTAR dataset, 11,501 had an available ILD status on HRCT, the gold standard for diagnosing SSc-ILD. At baseline, just over half (n=6,270) were ILD-positive (incident group), while 5,331 did not have ILD (at-risk group). Incidence was calculated as the rate per 100 person-years, starting from the first hospital visit.

Results showed that new-onset ILD occurred in 1,075 (20.2%) patients in the at-risk group after a median follow-up of 3.8 years. Surprisingly, the incidence of new-onset ILD was independent of disease duration. Overall incidence was 3.83 per 100 person-years and was found to occur anytime during a 10-year observation period. Among other variables, the following factors were found to predictive of ILD in the long term: age (HR 1.0; 95% CI 1. –1.02), male sex (HR 1.4; 95% CI 1.1–1.8), history of arthritis (HR 0.7; 95% CI 0.5–0.9), dyspnea NYHA stage≥2 (HR 1.4; 95% CI 1.1–1.7), anti-topoisomerase antibody positivity (HR 2.4; 95% CI 2.0–2.8), anti-centromere antibody positivity (HR 0.7; 95% CI 0.6–0.8), PM/Scl autoantibody positivity (HR 2.0; 95% CI 1.2–3.6), inflammatory markers (HR 1.4; 95% CI 1.2–1.7), number of HRCTs during FU (HR 0.5; 95% CI 0.5–0.5), and average time between HRCTs (HR 3.2; 95% CI 2.8–3.6).

The study had several limitations, such as the heterogeneity of the population, the limited number of patients (50%) who had a follow-up HRCT available, and the use of registry data with missing values and decentralised reading.

1. Petelytska L, et al. Incidence and risk factors for new onset of interstitial lung disease in systemic sclerosis: a EUSTAR analysis. 1700, ACR Convergence 2023, 10–15 November, San Diego, USA.

Medical writing support was provided by Michiel Tent.
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Posted on 1 December 20231 December 2023